Bottom Line:
A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels).Conclusion.Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.

ABSTRACTIntroduction. Type 2 diabetes mellitus (T2DM) is one of the most important obesity-related comorbidities. This study was undertaken to characterise the effect of the biliopancreatic diversion with duodenal switch (BPD-DS) in morbidly obese and nonmorbidly obese diabetic patients. Methods. Outcome of 74 obese diabetic patients after BPD-DS and 16 non-obese diabetic patients after BPD or gastric bypass surgery was evaluated. Insulin usage, HbA(1c)-levels, and index of HOMA-IR (homeostasis model assessment of insulin resistence) were measured. Results. A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels). Conclusion. BPD-DS leads to an improvement of T2DM in obese and non-obese patients. Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.

Mentions:
In group one, mean preoperative BMI was 46 kg/m2 (35–56), mean preoperative duration of insulin treatment was 6.5 years with a mean usage of 98 units of insulin per day. At time point of discharge, 15 patients did not need insulin any more and one year after the operation insulin therapy was terminated in all patients (Figure 1). HbA1c levels decreased from preoperatively 9.5 (mean) to 5.9 (mean) and 5.6 (mean) after 6 and 12 months without any dietary restriction (Figure 2). Only one patient needed an antidiabetic drug one year after the operation. In the group of non-obese patients, similar results were seen; at discharge, 13 patients were free of insulin, and, one year after the operation all patients were free of insulin. Patients after BPD-DS and BPD-Scopinaro showed slightly better results than patients after gastric bypass (data not shown).

Mentions:
In group one, mean preoperative BMI was 46 kg/m2 (35–56), mean preoperative duration of insulin treatment was 6.5 years with a mean usage of 98 units of insulin per day. At time point of discharge, 15 patients did not need insulin any more and one year after the operation insulin therapy was terminated in all patients (Figure 1). HbA1c levels decreased from preoperatively 9.5 (mean) to 5.9 (mean) and 5.6 (mean) after 6 and 12 months without any dietary restriction (Figure 2). Only one patient needed an antidiabetic drug one year after the operation. In the group of non-obese patients, similar results were seen; at discharge, 13 patients were free of insulin, and, one year after the operation all patients were free of insulin. Patients after BPD-DS and BPD-Scopinaro showed slightly better results than patients after gastric bypass (data not shown).

Bottom Line:
A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels).Conclusion.Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.

ABSTRACTIntroduction. Type 2 diabetes mellitus (T2DM) is one of the most important obesity-related comorbidities. This study was undertaken to characterise the effect of the biliopancreatic diversion with duodenal switch (BPD-DS) in morbidly obese and nonmorbidly obese diabetic patients. Methods. Outcome of 74 obese diabetic patients after BPD-DS and 16 non-obese diabetic patients after BPD or gastric bypass surgery was evaluated. Insulin usage, HbA(1c)-levels, and index of HOMA-IR (homeostasis model assessment of insulin resistence) were measured. Results. A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels). Conclusion. BPD-DS leads to an improvement of T2DM in obese and non-obese patients. Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.